[in Japanese]

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【Aim】 Skeletal muscle mass is analyzed using bioelectrical impedance analysis （BIA） or dual-energy X-ray absorptiometry （DXA）, generally. However, it is not always possible to measure them. We investigated estimation of skeletal muscle mass using eGFR ratio （eGFRcys/eGFR） and Cre/Cys ratio （creatinine/cystatin C）which derived from blood examination. Diagnostic accuracy of eGFR ratio and Cre/Cys ratio in assessment of sarcopenia and malnutrition were compared. 【Cases and Methods】 eGFR ratio and Cre/Cys ratio were calculated using serum creatinine （Cre） and cystatin C （Cys） among 151 hospitalized patients. Sarcopenia was diagnosed using AWGS2019, while malnutrition was diagnosed using GLIM criteria. Diagnostic accuracy of eGFR ratio （eGFRcys/eGFR） and Cre/Cys ratio were analyzed. 【Results】 Correlation （R²） with skeletal muscle mass index were eGFR ratio： male 0.315, female 0.434, Cre/Cys ratio： male 0.315, female 0.429. Diagnostic accuracy in assessment of severe sarcopenia were 90.1%（eGFR ratio）and 91.4%（Cre/Cys ratio）. Diagnostic accuracy in assessment of malnutrition by GLIM criteria were 91.4% （eGFR ratio）and 90.7%（Cre/Cys ratio）, respectively. Conclusions： No differences were found between eGFR ratio and Cre/Cys ratio in comparison of diagnostic accuracy of assessment of sarcopenia and malnutrition by GLIM criteria.

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【Objective】 Zinc， an essential trace element， circulates in the blood bound to albumin （Alb）. We examined the relationship between serum zinc levels and all-cause mortality in hemodialysis patients. 【Methods】 We measured the serum zinc levels in 505 chronic hemodialysis patients in our facility and this cohort was followed for approximately 3 years with all-cause mortality as the primary endpoint. Serum zinc levels were divided into tertiles and analyzed using the Kaplan–Meier method and the Cox proportional hazards model. Subgroup analysis of serum Alb was also performed. 【Results】 Serum zinc levels showed a significant positive association with GNRI （geriatric nutritional risk index） and serum biochemical values reflecting nutritional status such as serum P，Mg，T-chol，TG，TP，Alb，ChE，Hb levels. A total of 61 patients（12.1%）died during the follow-up period. Compared to the first tertile ［serum zinc，49（46-52）μg/dL］，the risk of death was lower in the second tertile ［serum zinc，59（57-61）μg/dL; HR 0.549，95%CI 0.303–0.995，p =0.048］and the third tertile [serum zinc，70（66-74）μg/dL ;HR 0.454，95%CI 0.241–0.857，p =0.015］groups. This relationship remained after adjustment for age and dialysis vintage， but disappeared when Alb was added as a covariate. In the subgroup analysis， better survival with higher zinc status was observed only in patients with Alb of 3.5 and 3.6g/dL. There were no differences in cardiovascular disease-related death， infection-related death， or cancer-related death between the three groups. 【Conclusion】 In dialysis patients， serum zinc levels were associated with life expectancy， but this relationship was affected by Alb.

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【Objectives】　One of the causes of malnutrition observed in approximately 40% of hospitalized older patients is anorexia due to chronic constipation and gastroesophageal reflux disease. The present study examined the effects of malted-rice　amazake intake on defecation and nutritional status in hospitalized older patients. 【Methods】　Twelve hospitalized older patients were administered with malted-rice amazake for six weeks, and their nutritional statuses, including Geriatric Nutritional Risk Index　（GNRI），defecation status, nutrient intake, and prescribed drugs, were investigated. 【Results】　The patientsʼ　 Constipation Assessment Scale （CAS）　scores improved from constipation to non-constipation between the pre-intervention （Pre）　to the intervention stage　（Int; p = 0.008）．Serum albumin levels were maintained and improved from the Pre（3.3±0.5 g/dl）　to the Int stage（3.4±0.5 g/dl），and then significantly deteriorated six weeks after the end of the malted-rice amazake intake　（post-intervention: 3.2±0.3 g/dl）．　The GNRI scores also followed a similar trend. These effects were more evident in the polypharmacy group, the subjects who consumed a higher number of prescribed medications prior to the intervention　（six or more）　compared to those in the non-polypharmacy group　（five or less）． 【Conclusion】　Malted-rice amazake intake was found to change the defecation statuses and improve the nutritional statuses of hospitalized older patients, suggesting an association with polypharmacy.

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